Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken L S, Muenz L R, Thase M E, Weiss R D, Gastfriend D R, Woody G E, Barber J P, Butler S F, Daley D, Salloum I, Bishop S, Najavits L M, Lis J, Mercer D, Griffin M L, Moras K, Beck A T
University of Pennsylvania Medical School, Philadelphia, USA.
Arch Gen Psychiatry. 1999 Jun;56(6):493-502. doi: 10.1001/archpsyc.56.6.493.
This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients.
Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Patients were assessed monthly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index-Drug Use Composite score and the number of days of cocaine use in the past month.
Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index-Drug Use Composite score. Individual group counseling plus GDC was also superior to the 2 psychotherapies on the number of days of cocaine use in the past month. Hypotheses regarding the superiority of psychotherapy to GDC for patients with greater psychiatric severity and the superiority of cognitive therapy plus GDC compared with supportive-expressive therapy plus GDC for patients with antisocial personality traits or external coping style were not confirmed.
Compared with professional psychotherapy, a manual-guided combination of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence.
这是一项多中心调查，旨在检验4种心理社会治疗方法对可卡因依赖患者的疗效。
487名患者被随机分配到4种手册指导治疗方法中的一种：个体药物咨询加团体药物咨询（GDC）、认知疗法加GDC、支持性表达疗法加GDC或单纯GDC。治疗强度较大，包括6个月内可能进行36次个体治疗和24次团体治疗。在积极治疗期间每月对患者进行评估，并在基线后的9个月和12个月进行评估。主要结局指标为成瘾严重程度指数-药物使用综合评分以及过去一个月内使用可卡因的天数。
与两种心理治疗方法以及单纯GDC相比，个体药物咨询加GDC在成瘾严重程度指数-药物使用综合评分上显示出最大改善。个体团体咨询加GDC在过去一个月内使用可卡因的天数方面也优于两种心理治疗方法。关于心理治疗对精神疾病严重程度较高患者优于GDC，以及认知疗法加GDC相比支持性表达疗法加GDC对具有反社会人格特质或外部应对方式患者更具优势的假设未得到证实。
与专业心理治疗相比，强化个体药物咨询与GDC的手册指导组合对治疗可卡因依赖具有前景。
